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It is estimated that Hepatitis C (HCV) occurs in about 0.15% of 6-11 year-olds and 0.4% of 12-19 year-olds. It is estimated that there are 23,000 to 46,000 children in the US with HCV.1 The actual number of children with HCV is unknown because children are not routinely tested for it.

Prior to 1992, the most common transmission route for HCV in children was through blood transfusion, blood products, and organ transplantation. Now that blood products and organs are screened for hepatitis C the most frequent transmission of hepatitis C in infants is mother-to-child transmission. The second most common transmission route in children and teenagers is in those who share equipment to inject drugs (needles, cookers, cotton, water, etc.)

Transmission of HCV from an HCV-infected mother-to-infant occurs about 6% of the time. It can occur up to 10% of the time if a mother is coinfected with HIV and hepatitis C. Also, a high viral load increases the risk of mother-to-infant transmission. Unfortunately, there are no effective strategies or drugs to prevent the transmission of HCV from mother to child.

When a baby is born to an HCV-infected mother, the child will acquire the mother’s HCV antibodies. For this reason, the child will not be tested for HCV antibodies for 18 months. This is the period that it takes for the baby’s body to clear out the mother’s antibodies.An HCV RNA or viral load test can be given as early as one month. It might be too early since the HCV RNA, or viral load fluctuates during the acute infection phase. Also, babies have a high rate of natural clearance. Most medical providers prefer to wait out the 18-month period to test for HCV antibodies and the confirmatory HCV RNA (viral load test).

Table 1. Children for whom screening is recommended.

Children and adolescents with unexplained elevated aminotransferasesChildren at risk for vertically acquired HCV

Children from regions with high prevalence of HCV (adoptees, refugees, immigrants)

Children and adolescents with HIV

Children or adolescents who are victims of sexual assault

Adolescents with multiple sexual partners

Adolescents who are or were intravenous drug users, even if only once in the past

Children or adolescents who have ever been on dialysis

Sexual partner of HCV-infected person

Children or adolescent who have received needle stick (needles, piercing or tattooing)*

*I read this recommendation with interest because we know that receiving a tattoo or piercing in a commercial parlor is safe. .

Chronic InfectionApproximately 75% of infants who are acutely infected with hepatitis C will continue to chronic infection. In children, the rate of disease progression is slow. There is, however, a small percentage (estimated at less than 2%) of children in whom there is a rapid rate of disease progression that could lead to fibrosis and cirrhosis.

Watch, Wait and ProtectA baby born to an HCV-infected mother should receive the hepatitis A and hepatitis B vaccines to protect the child from becoming infected with another liver disease. As well the baby and child should receive other immunizations to protect the health of the child.

Hepatitis C is not spread by casual contact and infected children should not be restricted from attending daycare or school. Children should be taught that they should not share toothbrushes, nail clippers, razors or any other items that have the potential to transmit hepatitis C.

Any drug, herb or supplement that the child is given should be screened to make sure that it is liver safe. When the child is older, a discussion should take place about sex, drugs, and alcohol.

Most importantly, a child should be medically monitored on a regular basis.

When to Tell a ChildTelling a child that they have hepatitis C can be one of the most difficult decisions a parent can ever make. The timing is the most important decision. The best advice is never to lie to a child. We have an excellent fact sheet that can provide plenty of advice to parents. http://hcvadvocate.org/hepatitis/factsheets_pdf/TellChild_HCV.pdf

TreatmentAs stated above most children have a slowly progressive disease. For the small percentage that have severe fibrosis or cirrhosis, immediate treatment may be needed. The decision to treat or not is never easy and in children it is even more difficult. Some questions that are important to consider include:

Can treatment be postponed until the interferon-free therapies are available?

Is there an interferon-free clinical trial that your child can enroll in?

Are you and your child ready to take on interferon treatment and the side effects?

The new medications are very expensive—there is always the possibility that your insurance company may not cover the new medications.

Current treatment of pegylated interferon plus ribavirin is approved for children who are three years and older with compensated cirrhosis.

Again, most children have slowly progressive disease, and it takes decades before serious liver disease develops. By this time, children will age to adults and be eligible for interferon- and ribavirin-free therapies that approach 100% effectiveness.

The FutureHepatitis C infections are on the rise. The so-called Second Epidemic of hepatitis C is affecting females equally as males. As a result, there will be many women of child-bearing age that will become pregnant and have children who may also have hepatitis C.

For the first time, there is an opportunity to prevent mother-to-child transmission. Direct-acting antiviral medications without ribavirin that are pregnancy category B.

Pregnancy Category B: In humans, there are no well-controlled studies. However, in animal studies, pregnant animals received the medicine, and the babies did not show any problems related to the medicine.

However, there have not been any clinical studies using the interferon- and ribavirin-free medications in pregnant women. As a result, studies are needed to evaluate the safety and effectiveness of these new drugs for the mother and the infant.

1American Liver FoundationSource: Hepatitis C in Children in Times of Changes, Robert D. Baker and Susan S. Baker Walters Kluwer Health, Inc.

It is estimated that Hepatitis C (HCV) occurs in about 0.15% of 6-11 year-olds and 0.4% of 12-19 year-olds. It is estimated that there are 23,000 to 46,000 children in the US with HCV.1 The actual number of children with HCV is unknown because children are not routinely tested for it.

Prior to 1992, the most common transmission route for HCV in children was through blood transfusion, blood products, and organ transplantation. Now that blood products and organs are screened for hepatitis C the most frequent transmission of hepatitis C in infants is mother-to-child transmission. The second most common transmission route in children and teenagers is in those who share equipment to inject drugs (needles, cookers, cotton, water, etc.)

Transmission of HCV from an HCV-infected mother-to-infant occurs about 6% of the time. It can occur up to 10% of the time if a mother is coinfected with HIV and hepatitis C. Also, a high viral load increases the risk of mother-to-infant transmission. Unfortunately, there are no effective strategies or drugs to prevent the transmission of HCV from mother to child.

When a baby is born to an HCV-infected mother, the child will acquire the mother’s HCV antibodies. For this reason, the child will not be tested for HCV antibodies for 18 months. This is the period that it takes for the baby’s body to clear out the mother’s antibodies.
An HCV RNA or viral load test can be given as early as one month. It might be too early since the HCV RNA, or viral load fluctuates during the acute infection phase. Also, babies have a high rate of natural clearance. Most medical providers prefer to wait out the 18-month period to test for HCV antibodies and the confirmatory HCV RNA (viral load test).

Table 1. Children for whom screening is recommended.

Children and adolescents with unexplained elevated aminotransferasesChildren at risk for vertically acquired HCV

Children from regions with high prevalence of HCV (adoptees, refugees, immigrants)

Children and adolescents with HIV

Children or adolescents who are victims of sexual assault

Adolescents with multiple sexual partners

Adolescents who are or were intravenous drug users, even if only once in the past

Children or adolescents who have ever been on dialysis

Sexual partner of HCV-infected person

Children or adolescent who have received needle stick (needles, piercing or tattooing)*

*I read this recommendation with interest because we know that receiving a tattoo or piercing in a commercial parlor is safe. .

Chronic Infection
Approximately 75% of infants who are acutely infected with hepatitis C will continue to chronic infection. In children, the rate of disease progression is slow. There is, however, a small percentage (estimated at less than 2%) of children in whom there is a rapid rate of disease progression that could lead to fibrosis and cirrhosis.

Watch, Wait and Protect
A baby born to an HCV-infected mother should receive the hepatitis A and hepatitis B vaccines to protect the child from becoming infected with another liver disease. As well the baby and child should receive other immunizations to protect the health of the child.

Hepatitis C is not spread by casual contact and infected children should not be restricted from attending daycare or school. Children should be taught that they should not share toothbrushes, nail clippers, razors or any other items that have the potential to transmit hepatitis C.

Any drug, herb or supplement that the child is given should be screened to make sure that it is liver safe. When the child is older, a discussion should take place about sex, drugs, and alcohol.

Most importantly, a child should be medically monitored on a regular basis.

When to Tell a Child
Telling a child that they have hepatitis C can be one of the most difficult decisions a parent can ever make. The timing is the most important decision. The best advice is never to lie to a child. We have an excellent fact sheet that can provide plenty of advice to parents. http://hcvadvocate.org/hepatitis/factsheets_pdf/TellChild_HCV.pdf

Treatment
As stated above most children have a slowly progressive disease. For the small percentage that have severe fibrosis or cirrhosis, immediate treatment may be needed. The decision to treat or not is never easy and in children it is even more difficult. Some questions that are important to consider include:

Can treatment be postponed until the interferon-free therapies are available?

Is there an interferon-free clinical trial that your child can enroll in?

Are you and your child ready to take on interferon treatment and the side effects?

The new medications are very expensive—there is always the possibility that your insurance company may not cover the new medications.

Current treatment of pegylated interferon plus ribavirin is approved for children who are three years and older with compensated cirrhosis.

Again, most children have slowly progressive disease, and it takes decades before serious liver disease develops. By this time, children will age to adults and be eligible for interferon- and ribavirin-free therapies that approach 100% effectiveness.

The Future
Hepatitis C infections are on the rise. The so-called Second Epidemic of hepatitis C is affecting females equally as males. As a result, there will be many women of child-bearing age that will become pregnant and have children who may also have hepatitis C.

For the first time, there is an opportunity to prevent mother-to-child transmission. Direct-acting antiviral medications without ribavirin that are pregnancy category B.

Pregnancy Category B: In humans, there are no well-controlled studies. However, in animal studies, pregnant animals received the medicine, and the babies did not show any problems related to the medicine.

However, there have not been any clinical studies using the interferon- and ribavirin-free medications in pregnant women. As a result, studies are needed to evaluate the safety and effectiveness of these new drugs for the mother and the infant.

1American Liver Foundation
Source: Hepatitis C in Children in Times of Changes, Robert D. Baker and Susan S. Baker Walters Kluwer Health, Inc.

Around 214,000 individuals are chronically infected with hepatitis C (HCV) in the UK, national estimates from Public Health England (PHE) suggest.

Injecting drug use continues to be the most important risk factor for HCV infection in the UK with half of people who inject drugs (PWID) are thought to have been infected in England and Wales; levels are lower in Northern Ireland (23%) and higher in Scotland (57%).

However, across the UK, more individuals are being tested and diagnosed and “over the last five years particular improvements have been seen in primary care where surveillance indicates that testing has risen by 21%, 46% and 53% in England, Northern Ireland and Scotland respectively”, PHE’s new report Hepatitis C in the UK states.

Around 214,000 individuals are chronically infected with hepatitis C (HCV) in the UK, national estimates from Public Health England (PHE) suggest.

Injecting drug use continues to be the most important risk factor for HCV infection in the UK with half of people who inject drugs (PWID) are thought to have been infected in England and Wales; levels are lower in Northern Ireland (23%) and higher in Scotland (57%).

However, across the UK, more individuals are being tested and diagnosed and “over the last five years particular improvements have been seen in primary care where surveillance indicates that testing has risen by 21%, 46% and 53% in England, Northern Ireland and Scotland respectively”, PHE’s new report Hepatitis C in the UK states.

The Centers for Disease Control and Prevention (CDC) released new estimates on the acute and chronic cases of hepatitis A, B and C:

Hepatitis A (HAV):

2013:Estimated acute cases and deaths from hepatitis A

Acute: 3,500–range: 2,500 to 3,900

Deaths: 80 (underlying contributing cause of death in most recent year available (2013))

Hepatitis B (HBV):

2013:Estimated acute, chronic and deaths from hepatitis B

Acute: 19,800—range: 11,300 to 48,500

Chronic: 700,000 to 1.4 million

Deaths: 1,873

Hepatitis C (HCV):

2013:Estimated acute, chronic and deaths from hepatitis C

Acute: 29,700—range: 23,500 to 101,400

Chronic: 2.7 to 3.9 million

Deaths: 19,368*

NOTE: Current information indicates these represent a fraction of deaths attributable in whole or in part to chronic hepatitis C.”

Editorial Comments: The good news is that vaccination against hepatitis A and B and education efforts are working to keep new infections, chronic infections and deaths consistent with previous years. Hepatitis A and B are in line with what have been previously reported and rates of new infections have leveled off. I personally believe that hepatitis B may be under reported especially in some larger populations of immigrants who may be infected with hepatitis B. Furthermore, we may not know the extent of chronic hepatitis B in the undocumented immigrant population.

HCV however, seems be getting worse. The range of acute HCV population is much likely higher since we really don’t have an effective surveillance system in our country. We have had large outbreaks of acute HCV in Wisconsin, Kentucky, Massachusetts, Indiana and elsewhere. I also believe the number of people with chronic hepatitis C is much higher and the deaths caused by hepatitis C is certainly higher. The CDC has a *(see note) that captures the deaths which are most likely under reported. Many times a death reported on a death certificate is listed as another cause when HCV or cirrhosis, liver cancer or a consequence of HCV may be listed instead.

On a sad note, the age group that had the highest rate of death was the 55 to 64 year old group with 51% of the total number of deaths—this is very young age for such a high death rate.

The Centers for Disease Control and Prevention
(CDC) released new estimates on the acute and chronic cases of
hepatitis A, B and C:

Hepatitis A (HAV):

2013:Estimated acute cases and deaths from hepatitis A

Acute: 3,500–range: 2,500 to 3,900

Deaths: 80 (underlying contributing cause of death in most recent year available (2013))

Hepatitis B (HBV):

2013:Estimated acute, chronic and deaths from hepatitis B

Acute: 19,800—range: 11,300 to 48,500

Chronic: 700,000 to 1.4 million

Deaths: 1,873

Hepatitis C (HCV):

2013:Estimated acute, chronic and deaths from hepatitis C

Acute: 29,700—range: 23,500 to 101,400

Chronic: 2.7 to 3.9 million

Deaths: 19,368*

NOTE: Current information
indicates these represent a fraction of deaths attributable in whole or
in part to chronic hepatitis C.”

Editorial Comments: The good news
is that vaccination against hepatitis A and B and education efforts
are working to keep new infections, chronic infections and deaths
consistent with previous years. Hepatitis A and B are in line with what
have been previously reported and rates of new infections have leveled
off. I personally believe that hepatitis B may be under reported
especially in some larger populations of immigrants who may be infected
with hepatitis B. Furthermore, we may not know the extent of chronic
hepatitis B in the undocumented immigrant population.

HCV however, seems be getting worse. The range of
acute HCV population is much likely higher since we really don’t have
an effective surveillance system in our country. We have had large
outbreaks of acute HCV in Wisconsin, Kentucky, Massachusetts, Indiana
and elsewhere. I also believe the number of people with chronic
hepatitis C is much higher and the deaths caused by hepatitis C is
certainly higher. The CDC has a *(see note) that
captures the deaths which are most likely under reported. Many times a
death reported on a death certificate is listed as another cause when
HCV or cirrhosis, liver cancer or a consequence of HCV may be listed
instead.

On a sad note, the age group that had the highest
rate of death was the 55 to 64 year old group with 51% of the total
number of deaths—this is very young age for such a high death rate.

The report “Hepatitis C–Pipeline Review, H1 2015” provides an overview of the Hepatitis C’s therapeutic pipeline. This report provides comprehensive information on the therapeutic development for Hepatitis C, complete with comparative analysis at various stages, therapeutics assessment by drug target, mechanism of action (MoA), route of administration (RoA) and molecule type, along with latest updates, and featured news and press releases. It also reviews key players involved in the therapeutic development for Hepatitis C and special features on late-stage and discontinued projects.

Hepatitis C is a liver disease caused by the hepatitis C virus. The virus can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness. There are many types of hepatitis C virus. The most common in the U.S. is type 1. No type is more serious than any other, but they respond differently to treatment. Hepatitis C is an increasing public health concern in the United States and throughout the world. Symptoms of Hepatitis C include jaundice, stomach pain, loss of appetite, nausea and fatigue. 3, 50,000 to 5, 00,000 people die each year from hepatitis C-related liver diseases.

The report “Hepatitis C–Pipeline Review, H1 2015” provides an overview of the Hepatitis C’s therapeutic pipeline. This report provides comprehensive information on the therapeutic development for Hepatitis C, complete with comparative analysis at various stages, therapeutics assessment by drug target, mechanism of action (MoA), route of administration (RoA) and molecule type, along with latest updates, and featured news and press releases. It also reviews key players involved in the therapeutic development for Hepatitis C and special features on late-stage and discontinued projects.

Hepatitis C is a liver disease caused by the hepatitis C virus. The virus can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness. There are many types of hepatitis C virus. The most common in the U.S. is type 1. No type is more serious than any other, but they respond differently to treatment. Hepatitis C is an increasing public health concern in the United States and throughout the world. Symptoms of Hepatitis C include jaundice, stomach pain, loss of appetite, nausea and fatigue. 3, 50,000 to 5, 00,000 people die each year from hepatitis C-related liver diseases.

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